Diagnosis of Enterobiasis
Perianal-rectal itching, as a characteristic symptom of enterobiasis, is the basis for a presumptive diagnosis. However, given that a complaint about perianal-rectal itching can occur in other diseases, including severe ones (hemorrhoids, rectal cancer, diabetes mellitus, neurodermatosis, Trichomonas colpitis, menopause, liver disease, etc.), objective confirmation is needed. diagnosis.
The indisputable confirmation of the diagnosis is a macroscopic examination, that is, the detection and then determination of the pinworm specimen delivered to the laboratory.
The main diagnostic method is the detection of helminth eggs left by the crawling female on the skin. The generally accepted scatological methods of laboratory diagnostics of helminthiasis for the detection of enterobiasis are not very informative, because due to the morphobiological features, pinworms do not lay eggs in the intestinal lumen. Therefore, during scatological examination, pinworm eggs are rarely found.
The main informative method for laboratory diagnostics of enterobiasis is a special microscopic method – the method of imprint or scraping.
The method of choice for examining children is the Graham method (1941) – an imprint on polyethylene tape with an adhesive layer. The effectiveness of the Graham method in a three-fold study with an interval of 7-10 days with the taking of material – an imprint in the morning (from 7 to 13), before the toilet of the perianal region, reaches 93%. In a comparative assessment, its effectiveness is 2 – 3 times higher than the method of perianal-rectal scraping.
To diagnose enterobiasis in adults, they often use the method of perianal-rectal scraping with a match sharpened in the form of a spatula, or with a cotton swab on a match soaked in a 50% aqueous solution of glycerin or 1% soda solution In the laboratory, the swab is washed off, rinsed in a solution that is centrifuged, obtained the precipitate is applied to glass and microscoped. With a spatula-match, the material is scraped onto a microscope slide.
Among other, previously used methods of laboratory diagnosis of enterobiasis, the Gimmelfarb method can be called. The method consists in placing a small cotton swab into the perianal area of the subject at night. In the morning, it is transferred with tweezers into a centrifuge tube with water, rinsed thoroughly, and then centrifuged and the sediment is microscoped.
Treatment of Enterobiasis
A necessary condition for the successful treatment of a patient with enterobiasis is the simultaneous implementation of the entire complex of preventive measures to prevent reinvasion. This is, first of all, strict adherence to the personal hygiene regime not only for the patient, but also for all contacts in the outbreak. Taking into account the high contagiousness of the invasion before the treatment of the revealed invasive, all contacts are subject to examination for enterobiasis – children by scraping, adults – by questioning. All identified infested in the outbreak, the family are subject to simultaneous deworming.
The main recommendations for the sanitary and hygienic regime in family foci of enterrebiosis include the following:
- enterobiasis is a disease of dirty hands, therefore, the cleanliness of hands and nails, the fight against the bad habit of biting nails, taking fingers in the mouth, washing hands with soap before eating is the basis of successful treatment;
- the infested should sleep in closed shorts, that is, with elastic bands not only around the waist, but also around the legs, change them daily;
- obligatory washing of the perianal area with soap and water at night and in the morning after sleep;
- in the presence of itching in the perianal region before bedtime, a soda cleansing enema is recommended; it is designed only for mechanical removal of worms from the rectum; calculation of baking soda – for an enema: 1/2 teaspoon per 1 glass of boiled room temperature water (garlic, milk-garlic, vinegar enemas are not recommended, since they irritate the rectal mucosa);
- daily body washing, bathing in the shower;
- daily change of bed linen and ironing it with a hot iron is effective, but difficult to do and, if all the above recommendations are followed, is not necessary.
In the presence of an invasion in young children, it is recommended, after an evening wash at night, to lay a small cotton swab smeared with vaseline ointment in the anus. This prevents the creeping of female pinworms, relieves the child from itching, in women and girls it prevents pinworms from crawling into the vagina.
According to A.V. Markin, even the appointment of only a cotton swab to a patient leads to a decrease in invasion by 1.5 – 6.1 times, while one drug treatment is only 1.9 times.
With the unconditional and high-quality implementation of these recommendations, the patient can be freed from the invasion without drug treatment.
However, as experience has shown, the recovery of the infested is carried out faster and more reliably if the complex is observed: drug treatment against the background of a sanitary and hygienic regime.
The main modern anthelmintic drugs for enterobiasis are pyrantel, vermox, piperazine, medamin, vormil.
Prevention of Enterobiasis
The set of measures to combat enterobiasis is aimed at identifying and improving the source of the invasion – a patient with enterobiasis – and preventing the transmission of the pathogen, i.e., rupture of the transmission mechanism.
The identification of those infested on a planned basis concerns, first of all, the most epidemiologically significant contingents: children of preschool institutions, schoolchildren of the first to fourth grades and personnel of preschool institutions should be examined once a year. Workers of the food group and persons equated to them, as well as persons visiting swimming pools, are subject to examination upon admission. All children admitted to hospitals of any profile are examined for enterobiasis. In clinics and children’s consultations, the examination is carried out according to clinical indications.
In children’s collectives, where more than 15% of those infested with pinworms were detected during a single examination using adhesive tape or by scraping from perianal folds, further examination is not carried out, since all children are subject to treatment. All children should be examined for enterobiasis in family foci with adhesive tape or scraping, and adults with a confidential survey about the presence of signs of the disease.
In case of identification of the infected among already working food workers and persons equated to them for the period of treatment, they are transferred to another job not related to ready-made food.
Deworming in preschool institutions is carried out by the medical workers of these institutions, and the family members of the infested families are carried out by a family doctor – a general practitioner or pediatrician. In a preschool childcare institution, special attention should be paid to children in whom the invasion is re-detected. The beds of such children should be set apart from the beds of others. Hygienic measures (going to the toilet, washing hands, etc.) these children should be carried out under the supervision of a teacher, the pots of such children should be treated with boiling water. These children should not be designated as dining room attendants, etc.
To prevent the scattering of pinworm eggs in the external environment and reinvasion during treatment and in the next 3 days after its completion, it is necessary: to carry out especially carefully daily wet cleaning of the premises using a soap-soda solution, followed by boiling rags; supervise children’s compliance with personal hygiene rules; underwear (panties) change daily after sleep; at night before bedtime and in the morning after bedtime, be sure to wash away patients; carpet runners, rugs, fleecy fabric of sofas, armchairs, vacuum clean and iron through a damp cloth with a hot iron; toys that can be washed should be washed with hot (at least 60 ° C) water, soft, expensive toys should be removed.
The quality control of all activities in the preschool educational institution is carried out by sanitary and epidemiological services, which necessarily provide for current preventive measures. These measures are also mandatory for family foci of enterobiasis, in which special attention is paid to the sanitary and hygienic state of the home and health education. It is in families that conversations are most effective in which they talk about the effect of pinworms on the body of the invasive, about the ways of infection and preventive measures. Evaluation of health-improving measures in foci of enterobiasis in preschool children’s institutions, schools, etc. is carried out by sanitary and epidemiological stations, which apply sanitary and helminthological measures – the study of washings and dust from household items: tableware, oilcloths of tables, furniture, carpets, bed and underwear, toys , chamber pots, floor, door handles, as well as from the hands of children, catering workers, staff of a children’s institution in the swimming pools examine the water.
This is provided for by current rules and guidelines.
Enterobiasis is a disease of dirty hands, therefore, for its prevention, children should be taught personal hygiene skills from early childhood. Fingernails should be cut short, nail biting and finger sucking should be prohibited at all times. It is advisable to carry out this against the background of game situations that are remembered by the child, and the advice becomes a habit.
The role of the family doctor – the main physician in the modern health care system – is very important and responsible. The improvement of the focus of enterobiasis in the family is an indicator of the quality of the work of the doctor – the curator of this family.
The level of infestation of people with pinworms should be considered as an indicator of the sanitary state of the environment and the cultural level of the population.